Acute kidney injury following endovascular intervention for peripheral artery disease

Abstract

Background The incidence of, and risk factors for, acute kidney injury (AKI) after endovascular intervention for peripheral artery disease (PAD) remain unknown. The aim of this study was to assess the proportion of patients who develop AKI and explore the risk factors. Methods Prospectively collected data on patients undergoing femoropopliteal endovascular intervention for symptomatic PAD across three vascular centres were analysed. The proportion of patients developing AKI (according to the Kidney Disease Improving Global Outcomes definition) within 48 h, and the proportion developing the composite Major Adverse Kidney Events (MAKE) endpoints (death, dialysis, drop in estimated glomerular filtration rate at least 25 per cent) at 30 days (MAKE30) and remains 90 days (MAKE90) were calculated. Multivariable regression analysis was used to assess predictors of AKI, and the association between AKI and death. Results Some 2041 patients were included in the analysis. AKI developed in 239 patients (11.7 per cent), with 47 (2.3 per cent) requiring dialysis within 30 days, and 18 (0.9 per cent) requiring ongoing dialysis. The MAKE30 and MAKE90 composite endpoints were reached in 358 (17.5 per cent) and 449 (22.0 per cent) patients respectively. Risk factors for AKI were age, sex, congestive heart failure, chronic limb-threatening ischaemia, emergency procedure, and pre-existing chronic kidney disease. AKI, dementia, congestive heart failure, and major amputation were risk factors for medium-term mortality. Conclusion AKI is a common complication after intervention for PAD and is associated with medium-term mortality.

Botulinum Toxin Type a for Treating Rest Pain in Chronic Limb-threatening Ischemia: A Case Report

“…1 Current studies reveal that the acute kidney injury cause by contrast is a common postoperative complication in PAD patients undergoing vascular surgery and endovascular therapy, the high-risk factors including advanced age (>75 years), CLTI, pre-existing chronic kidney disease, congestive heart failure, etc. 8,9 It makes endovascular treatments and operative treatments more difficult because of the risk of destructing the remaining renal function, especially the pre-existing renal insufficiency among CLTI patients lead to worse outcomes (including the incidence of major adverse cardiovascular events, target lesion revascularization, amputation, and high mortality). [8][9][10][11] So in our case, the conservative treatment was the most appropriate choice based on the risk estimation and the patients' option, but it is frustrating that the rest pain did not respond to conventional analgesic drugs and the opiate analgesia was not for prolonged use.…”

“…8,9 It makes endovascular treatments and operative treatments more difficult because of the risk of destructing the remaining renal function, especially the pre-existing renal insufficiency among CLTI patients lead to worse outcomes (including the incidence of major adverse cardiovascular events, target lesion revascularization, amputation, and high mortality). [8][9][10][11] So in our case, the conservative treatment was the most appropriate choice based on the risk estimation and the patients' option, but it is frustrating that the rest pain did not respond to conventional analgesic drugs and the opiate analgesia was not for prolonged use. In view of the sustained effect and safety have been proven in treating pain with BoNT/A, the patient accepted the subcutaneous injections of BoNT/A, the pain reduced rapidly and maintained a good effect after treatment.…”

Risk of Contrast-Associated Acute Kidney Injury in Patients Undergoing Peripheral Angiography with Carbon Dioxide Compared to Iodine-Containing Contrast Agents: A Systematic Review and Meta-Analysis

“…The potential mechanistic pathway of the association between CA-AKI and adverse clinical events remains to be elucidated and it is still under dispute to what extent CA-AKI represents a mediator or risk marker, especially in mild AKI cases [ 38 ]. It cannot be excluded that other factors beyond ICM contribute to the observed renal impairment, and some researchers have even questioned whether ICM plays a significant role at all in the observed deterioration in kidney function [ 8 , 15 ]. Therefore, the term CA-AKI, rather than the previously used contrast-induced acute kidney injury, has been adopted.…”

“…The reported risk of CA-AKI varies between 7% and 11% [ 2 , 4 , 8 , 9 , 10 , 11 ]. Substantially higher and lower rates were attributed to the use of different AKI definitions, different ICM administration modes (intravenous vs. intraarterial), ICM choice and dose, as well as the considerable heterogeneity in patient populations with respect to co-morbidities and the severity of underlying renal disease [ 2 ].…”

“…Importantly, it cannot be excluded that other factors beyond ICM contribute to the observed renal impairment and some researchers have even questioned whether ICM plays a significant role at all for the observed deterioration in kidney function [ 8 , 15 ], claiming that the risk of CA-AKI for the patient is overstated in the literature and overestimated by physicians [ 8 , 16 ]. Such overestimation of CA-AKI risk could even be harmful to patients if needed imaging procedures are delayed for unfounded fear of CA-AKI.…”